Benefits Summary 2020-2021 - Diocese of Palm Beach

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Benefits Summary 2020-2021 - Diocese of Palm Beach
2020-2021
Benefits Summary
Benefits Summary 2020-2021 - Diocese of Palm Beach
Welcome to your Benefit Enrollment!
                                      When Can I Enroll?
                                      There are up to three times during the year when you
   Here’s where to find…              will be able to elect or make changes to your benefits.
Enrollment Process          3         The choices you make will be in effect through July
                                      2021.
Login Instructions          4

Core Group Benefits         5

Medical                     6 - 10

Dental                      11

Vision                      12            When you’re first hired

                                           Your coverage begins on your benefit eligibility
Life Insurance              13
                                           date. This is the time to enroll in any of the
                                           plans without a qualifying event.
Disability                  14 - 15

Voluntary Benefits          16 - 17

Identity Theft Protection   18

Important Contacts          19
                                          If you have a life change

                                           Certain life events like birth or adoption of a
                                           child, change in marital status, death, or loss of
                                           coverage due to no fault of your own may allow
                                           you to change your coverage during the year.
                                           You must make your requested changes and
                                           provide your supporting documentation within
                                           30 days of the qualifying event.

                                          At Annual Enrollment

                                           Annual Enrollment is your opportunity once
                                           each year to evaluate your benefit options and
                                           make selections for the following year.
                                           Benefits selected at Annual Enrollment are
                                           effective August through July.
Benefits Summary 2020-2021 - Diocese of Palm Beach
2020-2021
                                                                               Diocese of Palm Beach Enrollment Guide

                               Enrollment Process
The Diocese of Palm Beach provides electronic enrollment through Explain My Benefits. Explain My Benefits
provides eligible employees the ability to make group insurance benefit elections and changes online during
the annual open enrollment, new hire orientation and qualifying events.

Enrollment has never been easier. Accessible 24 hours a day, information about all of your employee benefits
election options, premiums and carrier contact information are available to help you make informed decisions.

You can also log into the Explain My Benefits portal at anytime to review your benefits, access carrier links,
update your personal information for yourself and dependents, update your beneficiaries and process
qualifying life events.

              How to Enroll

              Self-Service
                 Visit www.explainmybenefits.com/diocese, click on the blue “Log into your benefit system”
                  button and move through the enrollment system at your own pace.
                 Login instructions on are page 4.
                 Be sure to click “Checkout” at the end of the process and make note of your confirmation. If
                  you do not receive a confirmation, you have not completed your enrollment and you will not
                  be enrolled for in your benefits.
                 Return to the system anytime to view your confirmation statement.

Reminders
   Be sure to review the 2020-2021 Benefit Guide and plan summaries prior to going through the enrollment
    process.
   Be prepared by gathering dependent and beneficiary information (i.e. Social Security Numbers and Dates
    of Birth).

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Benefits Summary 2020-2021 - Diocese of Palm Beach
Login Instructions

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Benefits Summary 2020-2021 - Diocese of Palm Beach
2020-2021
                                                                                                   Diocese of Palm Beach Enrollment Guide

                Overview of Core Group Benefits
Who is Eligible?
Employees working at least 30 hours each work week and their eligible dependents. Some benefits are restricted
offerings. Eligibility will be indicated for each benefit.

Dependents
An individual who meets the eligibility criteria specified below is an Eligible Dependent and is eligible for coverage under
this Booklet:
1. The Covered Employee’s Spouse*.
2. The Covered Employee’s natural, newborn, Adopted, Foster, or step child(ren) (or a child for whom the Covered
   Employee has been court-appointed as legal guardian or legal custodian) who has not reached the end of the
   Calendar Year in which he or she reaches age 26 (or in the case of a Foster Child, is no longer eligible under the
   Foster Child Program), regardless of the dependent child’s student or marital status, financial dependency on the
   Covered Employee, whether the dependent child resides with the Covered Employee, or whether the dependent
   child is eligible for or enrolled in any other health plan.
3. The newborn child of a Covered Dependent child who has not reached the end of the Calendar Year in which he or
   she becomes 26. Coverage for such newborn child will automatically terminate 18 months after the birth of the
   newborn child.
Note: If a Covered Dependent child who has reached the end of the Calendar year in which he or she becomes 26 obtains a dependent
of their own (e.g., through birth or adoption) such newborn child will not be eligible for this coverage and the Covered Dependent
child will also lose his or her eligibility for this coverage. It is the Covered Employee’s sole responsibility to establish that a child meets
the applicable requirements for eligibility.

*SPOUSE shall mean for all purposes of the Trust and each Plan of the Trust, the individual to whom the Member
Participant is civilly married under a marriage covenant between a man and a woman as described in Canon 1055 of the
Code of Canon Law (Codex Iuris Canonici) for the Latin Rite of the Catholic Church.

Medical and Dental - Dependent children up to age 26 regardless of financial dependency, residency, student status,
employment or marital status. Coverage ends the last day of the year the child turns 26.**

Vision - Dependent children up to age 30 regardless of financial dependency, residency, student status, employment or
marital status. Coverage ends the last day of the year the child turns 30.

**A Covered Dependent child may continue coverage beyond the age of 26 (Medical ONLY under employee’s payroll
deduction), provided he or she is:
         1.     unmarried and does not have a dependent;
         2.     a Florida resident or a full-time or part-time student;
         3.     not enrolled in any other health coverage policy or plan; and
         4.     not entitled to benefits under Title XVIII of the Social Security Act unless the child is a
                Handicapped dependent child.
         *Medical - For a separate monthly cost for EACH overage child:
                Overage Child Standard Plan - $576.30 per month
                Overage Child Premium Plan - $622.20 per month

         *Vision - Dependents will be covered under Employee & Child(ren) or Employee Family rates.

This eligibility shall terminate on the last day of the Calendar Year in which the dependent child reaches age 30.

Supplemental Term Life - Dependent children up to age 19 or 25, if a full-time student. Coverage ends the last day of the
year the child turns 19 or 25.
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Benefits Summary 2020-2021 - Diocese of Palm Beach
Group Benefit - Medical
             Plans                             Florida Blue Standard                                              Florida Blue Premium
                                   In Network                    Out-of-Network                       In Network                    Out-of-Network
    Deductible
     Individual                        $400                             $600                              $300                   Combined w/ In-Network
     Family                           $1,200                           $1,800                             $900                   Combined w/ In-Network
     Coinsurance                       20%                               50%                              10%                               30%
    Out of Pocket Maximum (Includes Deductible, Coinsurance, Co-pays, PAD and Rx)
     Individual                       $3,500                  Combined w/ In-Network                     $2,500                  Combined w/ In-Network
     Family                           $7,000                  Combined w/ In-Network                     $7,500                  Combined w/ In-Network
    Preventive Care
    Office Visit                   Covered 100%                   50% Coinsurance                     Covered 100%                   30% Coinsurance
    Mammograms                     Covered 100%                     Covered 100%                      Covered 100%                     Covered 100%
    Colonoscopy (age
                                   Covered 100%                   50% Coinsurance                     Covered 100%                   30% Coinsurance
    50+)
    Physician Office Visit
    Primary Care                    $25 Co-pay                     50% after Ded.                      $25 Co-pay                     30% after Ded.
    Specialist                      $50 Co-pay                     50% after Ded.                      $50 Co-pay                     30% after Ded.
    Diagnostic Labs              20% Coinsurance                   50% after Ded.                   10% Coinsurance                   30% after Ded.
    Complex Imaging                 $50 Co-pay                     50% after Ded.                      $50 Co-pay                     30% after Ded.
    Hearing Aids
    External hearing aids
    covered up to a max            20% after Ded.                  50% after Ded.                     10% after Ded.                  30% after Ded.
    of $4,500 within a 36
    month period
    Hospital Services, Urgent Care & Walk-In Clinics
    In-Patient Hospital
    Services (Out of               20% after Ded.            50% after Ded. + $500 PAD                10% after Ded.            30% after Ded. + $300 PAD
    Network PAD Applies)
    Outpatient Surgery             20% after Ded.                  50% after Ded.                     10% after Ded.                  30% after Ded.
    Emergency Room
                             20% after Ded. + $100 PVD       20% after Ded. + $100 PVD          10% after Ded. + $50 PVD         10% after Ded. + $50 PVD
    (PVD Applies)
    Urgent Care                     $25 Co-pay                     50% after Ded.                      $25 Co-pay                     30% after Ded.
    Prescriptions
                                                          Full cost at purchase and must file                                Full cost at purchase and must file
    Max Out of Pocket               $50 per Rx                                                         $50 per Rx
                                                              a claim for reimbursement                                          a claim for reimbursement
                                   30 Day Retail                                                      30 Day Retail
    Generic                          $5 Copay                                                          $5 Copay
    Formulary                       $35 Copay                                                          $30 Copay
    Non-Formulary                   $50 Copay             Full cost at purchase and must file          $45 Copay             Full cost at purchase and must file
                                   90 Day Retail              a claim for reimbursement               90 Day Retail              a claim for reimbursement
    Generic                        $12.50 Copay                                                      $12.50 Copay
    Formulary                      $87.50 Copay                                                        $75 copay
    Non Formulary                   $125 Copay                                                       $112.50 Copay
    Specialty Drugs          $350 Copay (30 day supply)              Not Covered                $200 Copay (30 day supply)              Not Covered

        Go to www.floridablue.com to locate a network provider. Please note that your out-of-pocket costs will be more if you
        choose to go to an out-of-network provider.
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Benefits Summary 2020-2021 - Diocese of Palm Beach
2020-2021
                   Diocese of Palm Beach Enrollment Guide

Group Benefit - Medical

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Benefits Summary 2020-2021 - Diocese of Palm Beach
Group Benefit - Medical

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Benefits Summary 2020-2021 - Diocese of Palm Beach
2020-2021
                   Diocese of Palm Beach Enrollment Guide

Group Benefit - Medical

                                                            9
Benefits Summary 2020-2021 - Diocese of Palm Beach
Group Benefit - Medical
     Important Terms
     Insurance can sometimes sound like a foreign language. Take a moment to review the meaning of these
     common terms to best understand your benefit plans.

      Copay                                                    Deductible
      A flat fee you pay whenever you use certain              The annual dollar amount you pay before your
      medical services, like a doctor visit.                   insurance begins paying deductible-eligible claims.
      Accrues toward your out-of-pocket maximum.               Accrues toward your out-of-pocket maximum.

      Coinsurance                                              Out-of-Pocket Maximum
      The percentage of covered expenses you continue to The most you will pay during the calendar year for
      pay after you’ve met your deductible and before you covered expenses. This includes copays,
      reach your out of pocket maximum.                   deductibles, coinsurance and prescription drugs.
      Accrues toward your out-of-pocket maximum.

      Network                                                  Balance Billing
      A specific group of doctors, facilities, hospitals and   The amount you are billed to make up the
      providers who contract with the insurance plan.          difference between what your out-of-network
      In-network providers are your lowest cost for care.      provider charges and what insurance reimburses.

                                                                                Balance Billing is in addition to, and
                                                                                does not count toward your out-of-
                                                                                pocket maximum

          Semi-Monthly (24 Pay Period) Rates                                    18 Pay Period Rates
                           Florida Blue       Florida Blue                             Florida Blue        Florida Blue
      Coverage Tier                                             Coverage Tier
                          Standard Plan      Premium Plan                             Standard Plan       Premium Plan
      Employee Only          $10.50             $32.00          Employee Only            $14.00              $42.67

      Employee + 1          $293.00            $337.00          Employee + 1            $390.67             $449.33

      Family                $401.50            $451.00          Family                  $535.33             $601.33

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2020-2021
                                                                                           Diocese of Palm Beach Enrollment Guide

                               Group Benefit - Dental
Good oral care enhances overall physical health, appearance and mental well-being. Problems with the teeth and gums
are common and easily treated health problems. Keep your teeth healthy and your smile bright with the Diocese of
Palm Beach dental benefit plan through Delta Dental.

                                                             Delta Dental PPO                       Delta Dental PPO
                                                                In-Network                          Out of Network*
Calendar Year Deductible
Per Individual                                                        $100                                   $100
Annual Plan Maximum (per individual)                                 $1,500                                 $1,500
Preventative Services
Oral examinations, routine cleanings,
                                                               Plan pays 100%                         Plan pays 100%
x-rays, fluoride treatment, space
                                                              Deductible waived                      Deductible waived
maintainers
Basic Services
Fillings, sealants, denture repairs,
                                                                 80% Covered                            80% Covered
endodontics, periodontics, oral surgery
Major Services
Crowns, inlays, onlays, cast
                                                                 50% Covered                            50% Covered
restorations, bridges, dentures

                                                                     Semi-Monthly
                                                                                                  18 Pay Period
                                          Coverage Tier             (24 Pay Period)
                                                                                                      Rates
                                                                         Rates
                                        Employee Only                      $0.00                        $0.00
                                        Employee + 1                       $51.50                       $68.67
                                        Family                             $66.50                       $88.67

Go to www.deltadentalins.com to locate a network PPO provider. Please note that your out-of-pocket costs may be
more if you choose to go to an out-of-network provider.

***Dependent children up to age 26 regardless of financial dependency, residency, student status, employment or marital
status. Coverage ends the last day of the year the child turns 26

*When you receive services from an Out of Network Dentist, the percentages in this column indicate the portion of Delta Dental’s
Out of Network Dentist Fee that will be paid for those services. The Out of Network Dentist Fee may be less than what your dentist
charges and you are responsible for the difference.

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Group Benefit - Vision
         Regular eye examinations cannot only determine your need for corrective eyewear, but also may detect
         general health problems in their earliest stages. Protection for your eyes should be a major concern to
         everyone. Vision benefits offered through VSP. Available to all employees.

          WellVision Exam                         Focuses on your eyes and overall wellness                          $10          Every plan year**
        Prescription Glasses                                                                                         $25        See frames and lenses
                                                $150 allowance for a wide selection of frames                    Included in
                Frame                            $170 allowance for featured frame brands                        Prescription    Every other plan year
                                                    20% off amount over your allowance                             Glasses
                                                                                                                 Included in
                                              Single vision, lines bifocal, and lined trifocal lenses
                Lenses                                                                                           Prescription       Every plan year
                                                 Polycarbonate lenses for dependent children
                                                                                                                   Glasses
                                                        Standard progressive lenses                                  $55
                                                       Premium progressive lenses                                 $95 - $105
            Lens Options                                                                                                            Every plan year
                                       Custom progressive lenses                                                 $150 - $175
                                                  Average 20-25% off other lens options
               Contacts                       $150 allowance for contacts; copay does not apply
                                                                                                                  Up to $60         Every plan year
         (instead of glasses)                     Contact lens exam (fitting and evaluation)
                                         Services related to diabetic eye disease, glaucoma and age-
                                        related macular degeneration (AMD). Retinal screening for
       Diabetic Eyecare Plus
                                       eligible members with diabetes. Limitations and coordination                  $20              As needed
             Program
                                         with medical coverage may apply. Ask your VSP doctor for
                                                                   details.
                                      Glasses and Sunglasses: 20% off additional glasses and sunglasses, including lens options, from any VSP doctor
                                      within 12 months of your last WellVision Exam.
          Extra Savings and           Retinal Screening: Guaranteed pricing on retinal screening as an enhancement to your WellVision Exam.
              Discounts               Laser Vision Correction: Average 15% off the regular price or 5% off the promotional price; discounts only availa-
                                      ble from contracted facilities.

                                                               Your Coverage with Other Providers
                                         Visit vsp.com for details, if you plan to see a provider other than a VSP doctor.
     Exam……….up to $45 Single Vision Lenses……..up to $30 Lined Trifocal Lenses……..up to $65 Contacts……..up to $105
     Frame……..up to $70 Lined Bifocal Lenses……..up to $50 Progressive Lenses……....up to $50
     *Coverage with a retail chain affiliate may be different. Once your benefit is effective, visit vsp.com for details.
     **Plan year begins in August

                                                                   Semi-Monthly                      18 Pay
                                    Coverage Tier
                                                               (24 Pay Period) Rates              Period Rates
                           Employee Only                                   $3.44                        $4.59
                           Employee & Spouse                               $6.86                        $9.15
                           Employee & Children                             $7.35                        $9.79
                           Family                                          $11.74                       $15.65

         Go to www.vsp.com to locate a network provider. Please note that your out-of-pocket costs may be more if you choose
         to go to an out-of-network provider.

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2020-2021
                                                                                   Diocese of Palm Beach Enrollment Guide

            Group Benefit - Term Life Insurance
Basic Term Life and AD&D
The Diocese of Palm Beach provides Basic Life and AD&D Insurance through The Standard for all eligible employees at
no cost to the employee. The Basic Life benefit is $25,000 and AD&D insurance benefit is $25,000.

                                                  Voluntary Supplemental Term Life
                                                  You also have the opportunity to purchase supplemental term life
                                                  coverage for yourself, spouse and dependent children. Please note
                                                  that dependent children include unmarried adopted, natural or
                                                  stepchildren age 14 days to age 19 (25 is full-time student).

                                                  Employee:
                                                  You may purchase in $10,000 increments up to a maximum of
                                                  $100,000.

                                                  Spouse:
                                                  You may purchase for your spouse up to 100% of your
                                                  elected amount in $10,000 increments up to a maximum of
                                                  $50,000.

                                                  Child(ren):
                                                  You may purchase for your child(ren) in $2,000 increments up to a
                                                  maximum of $10,000, not to exceed 50% of your elected amount.

                                                  Guaranteed Issue
                                                  Employee - $50,000
                                                  Spouse - $20,000
                                                  Child(ren) - $10,000
                                                  Guaranteed Issue is only for employees enrolling within the initial eli-
                                                  gibility enrollment period.

 Monthly Rate Per $1,000 of Life and AD&D         *An Evidence of Insurability (EOI) form will be required for amounts
 Age Band Employee & Spouse         Child(ren)    over the Guaranteed Issue or if enrolling or making changes after the
                                                  initial enrollment period. Coverage is subject to approval by The
    0-29             $.100             $.200
                                                  Standard.
   30-34             $.110
                                                  Note: Coverage reduces by 50% at age 70
   35-39             $.140
   40-44             $.200                                         Example: A 36 year old employee wants to
                                                                   purchase $50,000 of term life and AD&D
   45-49             $.260
                                                                                  insurance
   50-54             $.440
                                                                Coverage Amount                         $50,000
   55-59             $.730
                                                                # of Units/$1,000
   60-64             $1.04                                                                                    50
                                                                (Coverage Amount/$1,000)
   65-69             $1.57                                      Monthly Rate per $1,000
                                                                                                           .140
   70-100            $2.93                                      from table on left
                                                                Total Monthly Premium                     $7.00

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Group Benefit - Disability

     Long Term Disability
     Laity employees of the Diocese of Palm Beach are
     provided, at no cost to you, Long Term Disability (LTD)
     coverage, after one full year of employment with the
     Diocese. LTD coverage supplements your lost wages
     should you be unable to work due to an illness or injury.
     LTD coverage begins after missing the specific elimination
     period below due to a medically certified reason. Benefits
     are payable up to the specific benefit duration period
     below. Benefits may be off-set by deductible sources of
     income - please see your policy for details.

     Elimination Period:                 90 Days

     Monthly Benefit:           60% of your monthly earnings to
                                a maximum benefit of $3,000

     Maximum Benefit Period:
     Under age 61 to SSNRA*, but not less than 60 months
     Age 61        to SSNRA*, but not less than 48 months
     Age 62        to SSNRA*, but not less than 42 months
     Age 63        to SSNRA*, but not less than 36 months
     Age 64        to SSNRA*, but not less than 30 months
     Age 65        24 months
     Age 66        21 months
     Age 67        18 months
     Age 68        15 months
     Age 69+12 months

     *SSNRA (Social Security Normal Retirement Age), your normal
     retirement age is your retirement age under the Social Security Act
     where retirement age depends on your year of birth.

     Pre-Existing Condition: Conditions you received treatment
     for during the three months prior to the start of the
     coverage are excluded for the first 12 months of coverage.

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2020-2021
                                          Diocese of Palm Beach Enrollment Guide

Group Benefit - Disability
          Short Term Disability
          Available to Laity only.

          As an employee of the Diocese of Palm Beach, you are able to
          enroll in Short Term Disability (STD) coverage at your own
          expense. STD coverage supplements your lost wages should
          you be unable to work due to illness, injury or pregnancy.
          STD coverage begins after missing the specific elimination
          period below due to a medically certified reason. Benefits are
          payable up to the specific benefit duration period below.

          Elimination Period:                       14 days

          Maximum Benefit Period:                   11 weeks

          Weekly Benefit:            60% of your weekly earnings to a
                                     maximum benefit of $1,500

          Cost per $10 of weekly benefit: $.130

                   Calculation for Total Monthly STD Cost
          Example: Employee as a $52,000 annual salary and wants to pur-
                           chase short term disability
          Step 1   Indicate your weekly earnings                      $1,000
          Step 2   Multiply your weekly earnings by .60                 $600
          Step 3   Divide amount in Step 2 by 10 (if amount in
                                                                           60
                   Step 2 is more than $1,500 use 150)
          Step 4   Multiply the amount in Step 3 by the rate of
                   $0.130 to obtain your total STD monthly             $7.80
                   cost.

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Voluntary Individual Benefits
     What are Voluntary Benefits?
     Voluntary Benefits are offered to strengthen your overall
     benefits package. You customize the benefit based on your
     needs and affordability. Available to all employees.
     •   Ownership – Policies are fully portable and belong to you
         if you leave the Diocese, price and plan benefits remain
         the same
     •   Benefits are payroll deducted
     •   Cash benefits are paid directly to you, not to a hospital or
         to a doctor
     •   Benefits are paid regardless of any other coverage you
         may have
     •   Level premiums—Rates do not increase with age
     •   Guaranteed Renewable
     •   Designed to provide additional cash flow to assist with out of pocket medical costs and other bills

     The Voluntary Benefits offered are Accident and Universal Life with Long Term Care through Trustmark.

     Accident Plan
                                         A plan that helps pay for the unexpected expenses that can result from an accident.
                                         •      On and off-the-job coverage, 24 hours per day, 7 days per week
                                         •      Family coverage available
                                         •      Sports related injuries covered also
                                         Just a few examples of benefit included in the plan:
                                         •      Initial Doctor’s Office Visit: $200
                                         •      Hospitalization: $3,200 admission, $500 per day
                                         •      Fractures: up to $15,000
                                         •      Dislocation: up to $12,000
                                         Wellness Benefit Included: A wellness benefit is paid for routine physicals, vaccines,
                                         and health screening tests for each covered person. There is a 60-day waiting period,
                                         after initial enrollment, for this benefit.
                                         This benefit pays $50 per test per person, twice each year (maximum $100 annually
                                         per insured).
                                                                     Semi-Monthly (24 Pay Period)
                                                Coverage Tier                                          18 Pay Period Rates
                                                                               Rates
                                         Employee Only                            $8.91                          $11.87
                                         Employee & Spouse                       $14.76                          $19.67
                                         Employee & Children*                    $18.57                          $24.76
                                         Family*                                 $24.40                          $35.53
     *Dependents up to age 26 can be covered.
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2020-2021
                                                                              Diocese of Palm Beach Enrollment Guide

                   Voluntary Individual Benefits
Universal Life with Long Term Care
Universal Life with Long Term Care includes both a death benefit and a living benefit.

•   Trustmark Universal Life with Long Term Care is a permanent life insurance policy that is designed to
    match your needs throughout your lifetime. It pays a higher death benefit during your working years when
    expenses are high and you need maximum protection.
•   The Universal Life with Long Term Care policy is priced to remain the same cost to you until age 100.
•   The death benefit reduces at age 70 when the need for life insurance typically decreases.
•   The Living Benefit, Long Term Care never reduces and is 4% of the original death benefit per month for up
    to 25 months.
•   If you use the Long Term Care benefit, your death benefit amount does not reduce due to the Benefit
    Restoration feature included.
•   Coverage is available for spouse ($25,000) and children (child term rider).
•   Employee must enroll in coverage in order to cover spouse and/or children.
•   Available through age 64.

                                Special Underwriting at Initial Offering
                             Guaranteed Issue - $100,000 (Employee Only)

      If you waived this benefit previously, you must answer a few health questions and be approved for
      coverage.

Rates
This benefit is customized by each employee so rates vary, but can start as little as a few dollars a week. Your
specific rate will be calculated for you in the electronic enrollment system.

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Identity Theft Protection
     Identity theft in the United States is a major problem that continues to be on the rise. Professional protection and
     assistance have become important tools in fighting the identity theft epidemic.

     Thieves today can get a hold of your personal information from trash cans, dumpsters, stolen mail, and even shoulder
     surfing. Once thieves have your information, it’s a simple matter to open new fraudulent accounts and make purchases
     in your name.

     When you enroll in LifeLock, you can be confident knowing that they are available 24 hours a day, 7 days a week, and
     committed 100% to helping protect your information as if it were their own.

     LifeLock offers Proactive Protection in both of the plans offered:

     Benefit Elite Plan                                                    Ultimate Plan
     •     LifeLock Identity Alert System                                  Provides all of the benefits of the Benefit Elite Plan plus:
     •     Lost Wallet Protection                                          •   Stolen Funds Replacement - up to $1,000,000
     •     Address Change Verification                                     •   Credit Card, Checking & Savings with Account Activ-
     •     Black Market Website Surveillance                                   ity Alerts
     •     Live Member Service Support                                     •   Online Annual Credit Report
     •     LifeLock Privacy Monitor                                        •   Online Annual Credit Score
     •     Reduce Pre-Approved Credit Card Offers                          •   Checking & Savings Account Application Alerts
     •     Identity Restoration Support                                    •   Bank Account Takeover Alerts
     •     Stolen Funds Replacement - up to $100,000                       •   Credit Inquiry Alerts
     •     Fictitious Identity Monitoring                                  •   Online Annual Tri-Bureau Credit Reports & Scores
     •     Court Records Scanning                                          •   Monthly Credit Score Tracking
     •     Data Breach Notifications                                       •   File Sharing Network Searches
     •     Investment Account Activity Alerts                              •   Sex Offender Registry Reports
                                                                           •   Priority Live Member Service Support

     $1 Million Total Service Guarantee
     LifeLock’s proactive approach works to help stop identity theft before it happens. As a LifeLock member, if you become
     a victim of identity theft because of a failure in their service, they will help fix it at their expense, up to $1,000,000.

                                        Semi-Monthly                                        Semi-Monthly
                                                                 18 Pay Period                                       18 Pay Period
             Coverage Tier             (24 Pay Period)                                     (24 Pay Period)
                                                                     Rates                                               Rates
                                            Rates                                               Rates
                                                  Benefit Elite Plan                                Ultimate Plan (New)
         Employee Only                      $4.25                      $5.66                    $12.75                    $17.00
         Employee & Spouse                  $8.49                     $11.32                    $25.49                    $33.99
         *Employee & Children               $7.43                      $9.91                    $18.06                    $24.08
         *Family                            $11.68                    $15.57                    $30.81                    $41.08

     *Employee & Children and Family Tiers: You may enroll up to 8 children with 4 of those children between the ages of 18 and 26.

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2020-2021
                                                                           Diocese of Palm Beach Enrollment Guide

                              Important Contacts
Vendor                                  Phone                            Website

Medical
                                        800-345-3885                     www.floridablue.com
Florida Blue

Pharmacy
                                        800-771-4648                     www.elixirsolutions.com
Elixir Pharmacy Benefits

Dental
                                        800-521-2651                     www.deltadentalins.com
Delta
                                        Contact the Benefits office at
                                        the Diocese:
Life / STD / LTD                        Sandy Maulden:                   smaulden@diocesepb.org
The Standard                            561-775-9574
                                        Ana Jarosz:                      anaj@diocesepb.org
                                        561-775-9525
Vision
                                        800-877-7195                     www.vsp.com
VSP

Voluntary Benefits
                                        800-918-8877                     www.trustmarksolutions.com
Trustmark

Identity Theft Protection
                                        800-543-3562                     www.lifelock.com
LifeLock

Trustmark Claims Help
                                        321-296-8060, Option 2           service@explainmybenefits.com
Explain My Benefits
                                                                         Sandy Maulden
                                                                         561-775-9574
   For other questions please contact the Diocesan Benefits    Office:   smaulden@diocesepb.org

                        Or go to the website at:                         Ana Jarosz
               http://www.explainmybenefits.com/diocese                  561-775-9525
                                                                         anaj@diocesepb.org
                                                                         Fax: 561-775-9575

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Benefit Guide Description
This summary of benefits is not intended to be a complete description of the Diocese’s insurance
benefit plans. Please refer to the plan document(s) for a complete description. Each plan is governed
in all respects by the terms of its legal plan document, rather than by this or any other summary of the
insurance benefits provided by the plan.

In the event of any conflict between a summary of the plan and the official document, the official
document will prevail. Although the Diocese maintains its benefit plans on an ongoing basis, the
Diocese reserves the right to terminate or amend each plan in its entirety or in any part at any time.

For questions regarding the information provided in this overview, please contact your Diocese human
resources representative.
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